Mental illness has always posed a challenge to societies’ capacity to integrate and provide care for those who are affected by it. In contemporary societies, institutions explicitly hold the principle of integration of mental patients, and have established a set of rules and guarantees that ensure not only their integration but also the public provision of health care appropriate for their situation. Throughout the 19th century and the first half of the 20th century, the consolidation of a model of care in specialized hospitals-psychiatric hospitals-was based on both technical-scientific reasons (treatment of the patient) and humanitarian reasons (to put a stop to the confinement or the abandonment of a great number of people with mental illness). The criticism of psychiatric institutionalization would come later. In the 1960s, psychiatric institutions and psychiatry itself were the object of an intense debate which, at its most radical, denounced the repressive character of institutions and of discipline (Goffman, Foucault), their political role in controlling deviance from societal norms (Szasz), the total failure of therapeutic procedures (Wing and Brown), and the complete removal of the patient from his/her original social environment (Goffman). Given such criticism, people began to talk about alternatives to institutionalization, about "mental health services" in which the hospital is only one element among others (clinics, day care hospitals, patients' clubs, post-discharge units), about educational and vocational programs for the social (re)integration of patients. To a certain extent, deinstitutionalization was made possible by developments in psychopharmacology from the mid-1950s, which revolutionized psychiatric practice by suppressing the patients’ most severe symptoms and thus making them more open to psychotherapy and counseling. This led to a rethinking of questions of mental health, and influenced the development of community psychiatry. Portugal has experienced a distinctive process of deinstitutionalization which needs to be studied and evaluated in what concerns its effects. The 1998 Mental Health Act establishes that care is primarily provided at the level of the community and that local services constitute the base of the national system of mental health. But the fact is that local services of mental health have not been created, rehabilitation units are scarce, socio-occupational and residential programs are inadequate, and as far as we know there are no projects in this area. Thus, there is an urgent need to study the effects of this inconsistent process of deinstitutionalization on patients and their families. The present study focuses precisely on this question, addressing the impact of deinstitutionalization on the lives of patients in Portugal, the relations between healthcare institutions and citizens with mental illness, the role of families and social networks in providing care to patients, and the articulation of formal and informal mental health care. The study is concerned with tracing the evolution of deinstitutionalization policies, or simply mental health policies, identifying their premises and results and assessing the families’ capacity to respond in face of the inadequacy of public care provision. The study’s development will be based in the Sobral Cid Psychiatric Hospital in Coimbra (a participating institution in this project), and will involve an intensive analysis of the relations between the institution and its patients, their families and their original environment. The dominant techniques used will be observation, documental analysis and interviewing. In the second phase, we will select about 20 patients with different situations as regards institutionalization (institutionalized patients, new patients, outpatients), and study their relations with the hospital, with local health services, and with other formal or informal care providers. This snowball sample of patients will lead to the study of their households, their social networks, the local authorities from their original communities, and the health professionals to which they are assigned, in order to reconstitute the care structures that protect them. Each patient is expected to lead to 5 interviews on average. At the same time, there will be interviews with policy makers, mental health services officials, mental health professionals and leaders of patients associations, focusing on their perception of deinstitutionalization in Portugal, the positive and negative effects of changes, and improvements to be made in order to preclude negative effects. Finally, this study will be conducted in tandem with a similar study to be developed by NUCEM (Nucleus of Studies on Citizenship, Exclusion and Processes of Social Change, Postgraduate Program in Sociology at the Federal University of Pernambuco, Brazil), and this is expected to provide the basis for a very fruitful exchange in what concerns comparisons between policies and practices of mental health care.